On consumer advocacy and the diagnosis of mental disorders.

Abstract

This article provides a brief overview of the development of consumer and family advocacy activity during the past 40 years, mentioning the involvement of these groups in the treatment and research arenas and describing a dearth of such activities related to matters of diagnosis. In an attempt to address this relative inattention to diagnostic issues, the article continues by proffering a relative personal account and then reporting the results of a quasi-qualitative study that collected opinions about the diagnostic process from a selected sample of consumers. The results of the latter process indicate that these consumers' opinions primarily focus on issues of billing and insurance, labeling and stigma, axis issues, and multiple and/or changing diagnoses. The article concludes with guarded recommendations as to how mental health professionals can possibly improve the process of diagnosing persons with mental illnesses.

Utilizing Psychiatric Diagnosis and Formulation in the Clinical Process: Meeting the Needs and Expectations of Service Users

“…In some countries such heavily stigmatized associations have been seen as sufficiently important as to require a disorder being renamed, by national fiat (Sato, 2006 It is not uncommon for the service user to disagree with the diagnosis they are given. Both family members and service users report at times that the diagnosis did not match their interpretation of their experience, and came with too many negative associations to be accepted (Frese and Myrick, 2010;Moeke-Maxwell et al, 2008;Laird et al, 2010). Some felt that clinicians did not communicate with them in a way that allowed hope for the prospect of future health.…”

“…(Frese and Myrick, 2010) However, over time Myrick found that more diagnoses were added, and some were changed. As the "labels" shifted towards words that tend to be used derogatorily in the popular media, and were prefaced by descriptors such as "persistent", "life-long" and "devastating", her first response could not be maintained.…”

“…The negative stigma associated with mental illness and addiction, and with some diagnoses in particular, is a common theme in service user and family/carer literature (Frese and Myrick, 2010). In particular, psychotic spectrum disorders, such as schizophrenia or some bipolar disorders, as well as personality disorders, tend to come with more unfavourable associations (Hartnell and Lapsley, 2006;Laird et al, 2010).…”

“…Service users, for example, report the clinical process and its resulting diagnosis as impacting on their self esteem, their sense of self and identity, and influencing their hopefulness for their future (Frese and Myrick, 2010;Crumlish and Kelly, 2009;Barnett and Lapsley, 2006).…”

“…In addition to reliability and validity, if the system is going to be used and survive, utility is required. Central to utility in clinical psychiatry is the expectation that knowing the diagnosis allows the selection of the most effective treatment (Nice, 2003;APA 2006;Frese and Myrick, 2010).…”